Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 11/4/2021
Doctor's Notes on Psoriasis
Psoriasis is a chronic autoimmune skin disorder that causes patchy, red, scaly areas of skin. It typically affects the arms, legs, trunk, scalp, knees, elbows, and lower back but it may occur on any part of the skin. The most common form of psoriasis is called plaque psoriasis (psoriasis vulgaris).
Symptoms of plaque psoriasis include
- plaques that are red, raised,
- scaly skin affecting the scalp, elbows, and knees.
- The plaques may itch or burn.
- Flares (periods when the condition worsens) may last weeks to months.
- Plaques may split and bleed, especially when they occur over joints or on the palms or feet.
- Plaques may be surrounded by a halo or ring of blanched skin (Ring of Woronoff).
- Skin scales are silvery white and thickness varies.
Other symptoms of psoriasis include
- nail changes such as discoloration and separation from the nail bed at the fingertip.
In children, symptoms of plaque psoriasis may appear different. Plaques are not as thick and the affected skin is less scaly. Psoriasis often appears in the diaper region in infancy and in flexural areas (underarms, groin, perianal area) and the face in children.
What Is the Treatment for Psoriasis?
There is no cure for psoriasis, but treatments can relieve symptoms and decrease flare-ups.
Medical treatments for psoriasis include:
- Topical treatments (on the skin)
- Over-the-counter (OTC) topical treatments
- Salicylic acid
- Coal tar
- Lotion or cream moisturizers
- Bath solutions such as oil, oatmeal, Epsom salts
- Keratolytics to keep skin cells from building up usually contain an active ingredient of salicylic acid, lactic acid, urea, or phenol
- Apply coverings over topical treatments such as plastic wrap, cellophane, waterproof dressing, cotton socks or a nylon suit to keep area moist
- Anti-itch treatments such as calamine, hydrocortisone, camphor, diphenhydramine (Benadryl)
- Aloe vera, jojoba
- Prescription topical treatments
- Steroids
- Anthralin
- Calcipotriene (Dovonex)
- Calcipotriene and betamethasone (Taclonex)
- Tazarotene (Tazorec)
- Calcitriol (Vectical)
- Over-the-counter (OTC) topical treatments
- Phototherapy (light therapy)
- Psoralen + UVA (PUVA)
- Ultraviolet light B (UVB): broad band and narrow band
- Systemic treatments
- Biologics and biosimilars
- Tumor necrosis factor-alpha (TNF-alpha) inhibitors such as certolizumab pegol (Cimzia), etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), golimumab (Simponi and Simponi Aria)
- Interleukin 12 and 23 (IL-12, IL-23) inhibitors such as ustekinumab (Stelara)
- Interleukin 17 (IL-17) inhibitors such as secukinumab (Cosentyx), brodalumab (Siliq), and ixekizumab (Taltz)
- Interleukin 23 (IL-23) inhibitors such as tildrakizumab-asmn (Ilumya), risankizumab-rzaa (Skyrizi), and Tremfya (guselkumab)
- T-cell inhibitors such as Orencia (abatacept)
- Biosimilars to adalimumab (Humira): adalimumab-atto (Amjevita), adalimumab-afzb (Abrilada), adalimumab-adbm (Cyltezo), adalimumab-bwwd (Hadlima), adalimumab-fkjp (Hulio), and adalimumab-adaz (Hyrimoz)
- Biosimilars to infliximab (Remicade): infliximab-axxq (Avsola), infliximab-dyyb (Inflectra), infliximab-qbtx (Ixifi), and infliximab-abda (Renflexis)
- Biosimilars to etanercept (Enbrel): etanercept-szzs (Erelzi) and etanercept-ykro (Eticovo)
- Disease-modifying antirheumatic drugs (DMARDs) including tofacitinib (Xeljanz and Xeljanz XR)
- Traditional oral systemics
- Acitretin (Soriatane)
- Cyclosporine
- Methotrexate
- Off-label systemics, including hydroxyurea (Hydrea), isotretinoin, mycophenolate mofetil, sulfasalazine, and 6-Thioguanine
- Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen (Advil, Motrin)
- Biologics and biosimilars
Psoriasis : Test Your Medical IQ Quiz
QuestionPsoriasis causes the top layer of skin cells to become inflamed and grow too quickly and flake off.
See AnswerMust Read Articles:
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Guttate Psoriasis
Guttate psoriasis is a type of psoriasis that looks like small, salmon-pink drops on the skin. The word guttate is derived from the Latin word gutta, meaning drop. Other symptoms and signs include nail changes and itchy drop-like lesions. This type of psoriasis usually resolves on its own in a few weeks. More resistant cases may benefit from PUVA therapy. -
How Do You Get Rid of Psoriasis on Your Scalp?
Psoriasis is a skin condition that causes red, thick, scaly, and flaky skin. Scalp psoriasis has no cure, but treatments can help relieve symptoms such as topical treatments, phototherapy (light therapy), shampoos with salicylic acid or coal tar, and others. -
How Do You Treat Inverse Psoriasis?
Treatment for inverse psoriasis (a type of psoriasis that develops on skin folds such as the armpits, groin, under the breasts, the crease of the buttocks), includes a variety of topical ointments and creams, systemic treatments, and over-the-counter (OTC) topical treatments. -
How Do You Treat Toenail Psoriasis?
Psoriasis is a chronic autoimmune skin condition that can also involve the toenails and fingernails. Treatment for nail psoriasis usually involves topical treatments, corticosteroid injections, laser treatment, PUVA, methotrexate, retinoids, and others. -
Iritis
Iritis, or anterior uveitis, is an inflammation on the front part of the eye called the iris. The iris is the colored part of the eye that opens and closes the pupil of the eye. Trauma, infections, or autoimmune problems can all cause iritis. Iritis is typically treated with eyedrops or pills. -
Is Egg Good for Psoriasis?
Psoriasis is a chronic autoimmune condition that affects the skin. Because eggs contain an ingredient called arachidonic acid that has been shown to be a trigger for psoriasis symptoms, they would generally not be recommended. Other psoriasis triggers include red meat, dairy, sugar, gluten, alcohol, and nightshades (potatoes, eggplant, bell peppers, and certain spices). -
Is Psoriasis Contagious Sexually?
Psoriasis is a skin condition that affects the scalp, elbows, and knees. It is not contagious and therefore is not passed on from skin-to-skin contact, including sex. -
Nail Psoriasis
Psoriasis is a common condition. Psoriasis symptoms and signs include patches of raised red skin with silvery scales. Symptoms and signs of nail psoriasis include thickening and pitting. Treatment of nail psoriasis may include medications or removal of the nail. -
Plaque Psoriasis
Plaque psoriasis is the most common type of psoriasis. The skin is red and covered with silvery scales and is inflamed. Mild plaque psoriasis may be treated with topical therapy while severe cases of plaque psoriasis require systemic medications. -
Psoriasis Medications
There are a number of good treatment options to control the skin lesions of psoriasis. Topical agents are practical when treating localized disease. Phototherapy should be considered if the disease covers more than 5%-10% of the total body surface area. Systemic agents should be started only after both topical treatment and phototherapy have been carefully considered. -
Psoriatic Arthritis
Psoriatic arthritis is a specific autoimmune condition in which a person has both psoriasis and arthritis. Some psoriatic arthritis symptoms and signs include scaly red skin on certain areas of the body, nail changes, eye inflammation, iritis, and inflammation of the muscles and tendons where they connect to the bone. There are a variety of psoriatic arthritis types. The goal of psoriatic arthritis treatment medications and lifestyle changes is to control inflammation. -
Pustular Psoriasis
Pustular psoriasis is an uncommon form of psoriasis. People with pustular psoriasis have clearly defined, raised bumps on the skin that are filled with pus (pustules). Treatment incorporates topical therapy and systemic therapy. -
Scalp Psoriasis Vs. Dandruff: What Are the Differences?
Scalp psoriasis and dandruff cause similar symptoms such as red, scaly, flaky patches on the scalp, but they are different conditions. Psoriasis is a chronic autoimmune condition, while dandruff is a mild form of seborrheic dermatitis. -
Types of Psoriasis
Psoriasis is a chronic disease of the skin that affects approximately 5.5 million people in the United States. Typical characteristics of psoriasis are red, dry, patches of skin and inflammation. -
What Are the Differences Between Eczema and Psoriasis?
Eczema and psoriasis are skin conditions that have similar symptoms that are difficult to tell apart from one another. Eczema symptoms include itchy, red, inflamed, and scaly skin. Psoriasis symptoms include red, thick, scaly, and flaky skin that often appears as patches. -
What Are the Types of Psoriasis?
Psoriasis, an autoimmune skin condition, causes the skin to appear red, thick, scaly, and flaky. There are five types of psoriasis, which include plaque psoriasis, inverse psoriasis, guttate psoriasis, pustular psoriasis, and erythrodermic psoriasis. -
What Causes Psoriasis of the Scalp?
Roughly half of all people with psoriasis experience psoriasis of the scalp. Risk factors for psoriasis, including scalp psoriasis, can include family history, certain medications, infection, obesity, and smoking. -
What Causes Psoriasis on the Hands?
Psoriasis is a skin condition that causes the skin to be red, thick, scaly, and flaky. When a person has psoriasis on the palms of the hands or soles of the feet, it’s called palmoplantar psoriasis. Psoriasis on the hands may be caused by an overactive immune system. Risk factors may include family history, infections, medications, smoking, and obesity. -
What Does a Psoriasis Rash Look Like?
Psoriasis is an autoimmune condition that causes skin rashes anywhere on the body, including the scalp, groin, skin folds, lower back, elbows, and knees. Psoriasis rashes typically look red, thick, scaly, and flaky. They can also appear as silvery-white scales or red spots. -
What Does Psoriasis Look Like on Your Hand?
Psoriasis on the palms of the hands or soles of the feet is called palmoplantar psoriasis. Symptoms of psoriasis on the hands may include patches of skin on the hands (red or dark, thick and dry, or silvery-white scales). It may also cause the fingernails to appear pitted, thick, ridged, crumbly, or discolored. -
What Is Psoriasis?
Psoriasis is a skin disease that causes red raised patches of skin covered with silvery thick scales. Environmental factors and injuries may trigger psoriasis flare-ups. -
What Is the Difference Between Psoriasis and Plaque Psoriasis?
Psoriasis is a skin condition that causes red, thick, scaly, and flaky skin. Plaque psoriasis is a type of psoriasis that causes plaques on the skin, which are areas of skin that are thick, dry, red, or dark, with silvery-white scales. -
What Is the Main Cause of Psoriasis?
Psoriasis is a faulty immune response that causes your body to attack its own skin and sometimes joints. The exact cause is unclear, but family history seems to play a role, as does the stress response to infection, medication side effects or prolonged emotional stress. -
What Triggers Psoriasis Flare-Ups?
The cause of psoriasis is believed to be an overactive immune system, but is not known. Triggers for psoriasis flare-ups include stress, skin injury (scratches, bug bites, sunburns, and vaccinations), illness or infection, allergies, certain foods, alcohol, environmental factors, and weather.
REFERENCE:
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.